93 Decision Citation: BVA 93-16356
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 90-26 772 ) DATE
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THE ISSUES
1. Entitlement to service connection for a psychiatric disorder, to
include post-traumatic stress disorder.
2. Entitlement to an increased evaluation for arthritis of the left
shoulder, with a history of dislocation, postoperative, currently
rated as 10 percent disabling.
REPRESENTATION
Appellant represented by: The American Legion
WITNESSES AT HEARING ON APPEAL
The veteran and M. Jeffcoat
ATTORNEY FOR THE BOARD
J. W. Loeb, Counsel
INTRODUCTION
The veteran served on active duty from January l964 to January l966
and from March l966 to March l969.
In February 1992, the Board of Veterans' Appeals (Board) remanded
this case to the Columbia, South Carolina, Regional Office (RO) for
additional development, to include a special orthopedic examination.
An examination was conducted in March 1992; and, based on the results
of the examination, a July 1992 rating decision granted an increased
evaluation of 10 percent for the veteran's left shoulder disorder. A
supplemental statement of the case was issued in March 1993. This
case was returned to the Board in May 1993. The veteran has been
represented throughout his appeal by the American Legion, which
submitted additional written argument in July 1993.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that the RO committed error in not granting
service connection for a psychiatric disorder because this was
incurred as a result of the stress of being a medical corpsman who
had to handle dead bodies, including three people who hung
themselves. It is maintained that an increased evaluation is
warranted for the veteran's left shoulder disorder because of the
negative impact that his left shoulder has on his ordinary activities
and employment.
DECISION OF THE BOARD
In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991),
following review and consideration of all evidence and material of
record in the veteran's claims file, and for the following reasons
and bases, it is the decision of the Board that the preponderance of
the evidence is against the veteran's claims for service connection
for a psychiatric disorder, to include post-traumatic stress
disorder, and for an evaluation in excess of 10 percent for his left
shoulder disorder.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable determination of
the veteran's appeal has been obtained by the RO.
2. A psychiatric disorder, including post-traumatic stress disorder,
was not manifest during service or soon after discharge, and the
psychiatric disorder diagnosed several years after discharge is
unrelated to service.
3. Orthopedic examination in March 1992 revealed forward flexion of
the left shoulder to 130 degrees and abduction to 140 degrees; the
veteran does not have recurrent dislocation at the scapulohumeral
joint.
4. The veteran's service-connected left shoulder disorder does not
involve an unusual disability picture with such factors as marked
interference with employment or frequent periods of hospitalization.
CONCLUSIONS OF LAW
1. A psychiatric disorder, including post-traumatic stress disorder,
was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110,
1131, 5107(a) (West 1991).
2. An evaluation in excess of 10 percent for the veteran's service-
connected left shoulder disorder is not warranted. 38 U.S.C.A.
§§ 1155, 5107(a) (West 1991); 38 C.F.R. § 3.321(b)(1), Part 4,
§ 4.71a, Diagnostic Code 5003 (1992).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Board finds that the veteran's claim is well-grounded within the
meaning of 38 U.S.C.A. § 5107(a); that is, it is not inherently
implausible. We also find that the facts relevant to the issues on
appeal have been properly developed and that the statutory obligation
of the VA to assist the veteran in the development of his claim has
been satisfied. 38 U.S.C.A § 5107(a).
In order to establish service connection for a claimed disability,
the facts, as shown by the evidence, must demonstrate that a disease
or injury resulting in current disability was incurred during active
service or, if preexisting active active service, was aggravated
therein. 38 U.S.C.A. §§ 1110, 1131.
Although the veteran maintains that he has a psychiatric disorder
because of the stress incident to his duties in service as a medical
corpsman, the medical evidence on file does not support this
contention. There were no complaints or findings either during
service or on VA examination in April 1969 of a psychiatric disorder.
The first post-service notation of a psychiatric disorder was not
until April 1974, which is over 5 years after service discharge, when
the veteran was hospitalized for headaches and depression. The
explanation given during this hospitalization for the veteran's
complaints involved personal problems; there was no mention of the
veteran's military service. Latent schizophrenia with paranoid
features, depressive neurosis, and tension headaches were diagnosed.
In l989 the VA diagnosis was organic affective and delusional
syndrome. There is no medical evidence on file that the veteran's
post-service psychiatric disorder is related to his military service.
We also note that there is no diagnosis of a post-traumatic stress
disorder on file. Consequently, we find that service connection for
a psychiatric disorder, including post-traumatic stress disorder, is
not warranted. 38 U.S.C.A. §§ 1110, 1131.
Disability evaluations are determined by the application of a
schedule of ratings that is based on the average impairment of
earning capacity in civilian occupations resulting from specific
injuries or combination of injuries. 38 U.S.C.A. § 1155. Separate
diagnostic codes identify the various disabilities. 38 C.F.R. Part
4.
The veteran's service medical records reveal that he dislocated his
left shoulder in April 1968 when he slipped on some ice. He was
hospitalized for left shoulder surgery from August to October 1968;
the hospital discharge diagnosis was chronic dislocation of the left
shoulder. When the veteran was seen in January 1969, it was noted
that his left shoulder repair had healed and that there was full
range of motion, except for some loss of external rotation. On VA
examination of the veteran's left shoulder in April 1969, there was
normal pain-free motion without crepitus or atrophy. The diagnosis
on VA examination in April 1974 was residuals of habitual dislocation
of the left shoulder, successfully treated by surgery.
Although Robert L. Sawyer, M.D., indicated in a July 1974 letter and
a December 1989 examination report that the veteran had pain and
limitation of motion of the left shoulder due to bursitis, Dr. Sawyer
did not provide any range of motion figures. According to an October
1991 letter from Guy C. Heyl, Jr., M.D., forward flexion of the
veteran's left shoulder was 135 degrees and abduction was 85 degrees;
X-ray studies of the left shoulder were noted to show degenerative
arthritis. Dr. Heyl concluded that the veteran was unable to use his
left shoulder for hard manual work. On VA orthopedic examination of
the veteran's left shoulder in March 1992, there was no swelling,
deformity or instability, although there was some tenderness at and
inferior to the coracoid process. Forward flexion of the left
shoulder was 130 degrees and abduction was 140 degrees. X-ray
studies of the left shoulder were interpreted by the radiologist as
showing minimal degenerative changes at the glenohumeral joint.
According to the Schedule for Rating Disabilities, degenerative
arthritis established by X-ray findings will be rated on the basis of
limitation of motion under the appropriate diagnostic codes for the
specific joint or joints involved. When the limitation of motion of
the specific joint or joints involved is noncompensable under the
appropriate diagnostic codes, a rating of 10 percent is for
application for each such major joint or group of minor joints
affected by limitation of motion. Limitation of motion must be
objectively confirmed by findings such as swelling, muscle spasm, or
satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Code
5003. A 20 percent evaluation is assigned when motion of the arm is
limited to shoulder level. 38 C.F.R. § 4.71a, Code 5201.
Alternatively, a 20 percent evaluation is assigned when there are
infrequent episodes of recurrent dislocation of the humerus at the
scapulohumeral joint and guarding of arm movement at shoulder level.
38 C.F.R. § 4.71a, Code 5202.
Although recent medical evidence reveals that the veteran does have
degenerative arthritis of the left shoulder with some limitation of
motion, recent range of motion studies show that this limitation of
motion is not severe enough to be compensable under the provisions of
Diagnostic Code 5201. 38 C.F.R. § 4.71a, Code 5201. Additionally,
there is no recent evidence of recurrent dislocation of the left
shoulder joint, which means that a 20 percent evaluation is not
warranted under the provisions of diagnostic code 5202.
38 C.F.R. § 4.71a, Code 5202. Consequently, an increased evaluation
for the veteran's service-connected left shoulder disorder is not
warranted.
We have also considered the provisions of 38 C.F.R. § 3.321(b)(1)
regarding the assignment of extraschedular evaluations. We find this
provision to be inapplicable to the case before us because the
disability picture is not exceptional or unusual, with such related
factors as marked interference with employment or frequent periods of
hospitalization, as to render impractical the application of the
regular schedular standards. Id.
ORDER
Service connection for a psychiatric disorder, to include post-
traumatic stress disorder, is denied. An increased evaluation for
arthritis of the left shoulder, with history of dislocation, post-
operative, is denied.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
EUGENE A. O'NEILL
PHILIP E. WRIGHT
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans'
Appeals Section, upon direction of the Chairman of the Board, to
proceed with the transaction of business without awaiting assignment
of an additional Member to the Section when the Section is composed of
fewer than three Members due to absence of a Member, vacancy on the
Board or inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section proceed with
the transaction of business, including the issuance of decisions,
without awaiting the assignment of a third Member.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a
decision of the Board of Veterans' Appeals granting less than the
complete benefit, or benefits, sought on appeal is appealable to the
United States Court of Veterans Appeals within 120 days from the date
of mailing of notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402
(1988). The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision which
you have received is your notice of the action taken on your appeal
by the Board of Veterans' Appeals.